Toward smoke-free multi-unit dwellings

Multi-unit dwellings—our homes—currently represent a glaring and ironic deficiency in our efforts to limit exposure to secondhand smoke. However, the issue is now being increasingly recognized as both important and modifiable.

In British Columbia, as elsewhere in the world, we have become increasingly protected against the dangers and nuisance of secondhand smoke in many settings, including at work and in public. Ironically, for those of us living in multi-unit dwellings, be it as renters or owners, one setting in which there remains virtually no protection is where we spend the most time—in our homes.

In 1964 Surgeon General Luther Terry made clear the immense dangers of smoking, yet two generations later smoking remains, by far, the leading preventable cause of death in Canada and worldwide. In fact, worldwide mortality is rising rapidly. As shameful as that is, it is the effects that the smoker has on others that is most unambiguously morally unacceptable.

Secondhand smoke contains over 50 known cancer-causing chemicals, and the surgeon general has determined that no level of exposure to secondhand smoke can be considered safe.[1]

Certain individuals are at increased risk, including pregnant women and their fetuses, infants and children, and adults with asthma or pre-existing heart disease. A very re­cent estimate put total deaths from secondhand smoke worldwide at 600000.[2]

Given recent and ongoing trends toward urban densification, an increasing fraction of the population is now living in multi-unit dwellings (i.e., apartments and condominiums), and potentially exposed to the secondhand smoke of their neighbors. This occurs both indoor and outdoors.

Indoors, secondhand smoke seeps through connections between units via the ventilation system, electrical outlets, cracks and gaps in the walls and floors, and around sinks, countertops, and radiators, and off-gassing from carpets.

Outdoors, secondhand smoke rises from balconies of units below, preventing use of one’s patio and entering the homes of nonsmokers unless windows are always kept shut (especially problematic during summertime). Toxic residues persist on indoor surfaces, such as furniture and flooring, and are later re-emitted, a phenomenon referred to as thirdhand smoke.

The scope of the problem is quite surprising, and it is detailed by a 2008 BC Stats survey commissioned by the Heart and Stroke Foundation of BC and Yukon on their related smokefreehousingbc.ca website[3] (an excellent resource which also lists actions that may be taken by those having the problem).

Thirty-four percent of apartment- and condominium-dwellers are expos­ed to unwanted secondhand smoke from their neighbors, and about half of those are bothered “quite a bit” by it. Nevertheless only 23% of those exposed complain to their landlords, with most failing to recognize that they are not alone, and instead suffering the problem in silence.

BC Stats calculates that up to 100 000 BC renters may move annually over this issue. A strong majority of those surveyed would prefer to live in a 100% smoke-free (including balconies) building—similar to results in surveys elsewhere. However, almost none exist in BC.

In downtown Vancouver this is true at any price level, as confirmed by my searches and communications with Condominium Home Owners’ Association of BC president Tony Gioventu, who brings the issue up regularly in the association’s seminars.

A parallel survey on the same site revealed that most strata corporations and apartment owners/managers recognize that there is a market for smoke-free housing and expect the issue to become more important in the future; however, to date, a combination of inertia and a misplaced fear of transgressing so-called smokers’ rights have prevented this from being translated into building policy or governmental legislation.

Although few academic studies have specifically looked at secondhand smoke exposure in multi-unit dwellings, two recent articles are worthy of mention.

One looked at actual gas transfer between units in buildings of various ages before and after careful implementation of best practice air-sealing procedures and ventilation improvements.

It concluded that while transfer was less in newer buildings, and moderately reduced after treatments, it could not be eliminated (including in units meeting LEED [Leadership in Energy and Environmental Design] criteria), and that such modifications were not a practical means of solving secondhand smoke transmission.[4]

In the second, children in nonsmoking homes living in apartments had 45% higher cotinine levels than those living in detached houses.[5] Author Dr Jonathan Winickoff commented to the BBC, “If your neighbors are smoking then you are exposed if you live through the wall… in apartment buildings this effect is magnified. Smoke contaminates the whole building.”[6]

The concept that separate smoking and nonsmoking areas are ineffective is already reflected in the 100% smoke-free status of public buildings and hotels, where smoking floors are no longer permitted in much of the world, including here in British Columbia. Visitors to our cities are better protected against secondhand smoke than residents.

Accordingly, preventing secondhand smoke exposure in multi-unit dwellings is becoming increasingly recognized as a significant unmet need, including being cited by a recent New England Journal of Medicine article,[7] and included in the 2010 shadow report, Canada’s Implementation of the Framework Convention on Tobac­co Control, prepared by Physicians for a Smoke-Free Canada[8] and others.

Furthermore, a memorandum issued by the Department of Housing and Urban Development on 17 July 2009 stated that it “strongly encourages public housing authorities to implement nonsmoking policies in some or all of their public housing units,” an important shift in American federal policy.[9]

The inevitable response of smokers toward any call for increased availability of smoke-free housing is predictable. Tobacco is a legal product, and it is their presumed “right” to be allowed to smoke in their homes.

However, multiple legal opinions have concluded that no such right exists, only, for the moment, an unregulated freedom (court cases to date have tended to side with the nonsmoking complainants, but these are time-consuming and expensive—it is currently much easier to move and hope the problem doesn’t recur).

Multi-unit dwellings represent a conflict of individual freedoms with respect to smoking, and one side must be given precedence over the other. We currently have bylaws prohibiting one from disturbing one’s neighbors in many comparatively minor ways. Prohibiting smoking in multi-unit dwellings is no different from prohibiting loud music or pets. That something is legal does not mean it is unregulated.

Approximately two-thirds of smokers already avoid smoking inside their homes.[3] Requiring smokers to keep their smoke out of the homes of others as well is not too much to ask.

While any strata council or apartment owner can currently convert their building to a smoke-free status, only a very few have done so, despite obvious benefits including decreased maintenance and insurance costs, decreased fire risk, and improved tenants’ health.

Several jurisdictions in Canada and the US have implemented smoke-free policies for at least some of their public housing, including here in Vancouver. Several small cities in California have gone further, with partial or total bans applied to all multi-unit dwellings. If a total ban, although justifiable, is currently viewed as politically untenable, there are several less controversial steps that could be taken.

These include:• Requiring all future buildings to be smoke-free (addressing the gross imbalance/social injustice of the current ratio of nonsmokers desiring smoke-free buildings to smoke-free multi-unit dwellings in the city of Vancouver and elsewhere).

• Requiring a contiguous portion of existing buildings to be declared smoke-free (such would require grandfathering, but an effect would be seen over time).

• Requiring leases to state the smoking status of units and floors.

• Listing secondhand smoke as a nuisance and breach of the “right to quiet enjoyment” in the Residential Tenancy Act so that this doesn’t have to be repetitively established in each incident or litigation.

• Various incentives for strata councils and rental building owners to convert to a nonsmoking status.

• An educational campaign aimed both at getting smokers to avoid smoking in their units and informing exposed nonsmokers of their rights and options.

I urge you to ask your patients living in multi-unit dwellings whether they are being exposed to unwanted secondhand smoke and, if so, educate them on what steps they may take toward a remedy. They should no longer remain among the many currently suffering in silence.

It seems Iro Cyr has been smoking something a little stronger -- albeit less deadly -- than tobacco! WHEN DID BREATHING (toxic and carcinogenic TOBACCO) SMOKE-FREE AIR BECOME A "SPECIAL NEED" OR A "SPECIAL PERSONAL REQUIREMENT" (of 85% of the population, I might add)?
And if we're not prepared to put up with your Second-Hand Indoor Tobacco Smoke (interesting and extremely appropriate acronym there!), we're "intolerant"? You, Mr. Tolerant, would obviously not object to me sprinkling a little asbestos dust into your breathing space, right? And if I'm your next door neighbour and I decide to crank my stereo at 4:00 a.m., you won't mind, will you? Oh, and those pesky drunk driving laws: The ultimate in intolerance!!! To hell with the "special needs/personal requirements" of all those sober drivers, cyclists and pedestrians out there! They need to stay out of your way, right?
The flaws in your colourful argument are explained in the article itself (perhaps you couldn't see it clearly, through the haze)...and are as follows:
1. A survey documented that it is the strong majority who would prefer to live in a completely smoke-free building, not just "the exceptions";
2. Your analogies are flawed (and often incorrect) in that, unlike the situations you mention, second-hand smoke is a documented health hazard regarding which the Surgeon General states no level of exposure can be considered safe. Furthermore, smell does indeed imply exposure to the gases in question, the levels of which are often far from miniscule; and

3. The problem is not that some buildings are not smoke-free, but that virtually none are, despite smokers being a small minority of the population. To use your analogy: How would the handicapped react if there weren't any buildings at all with elevators?
In response to all of your, 'Do [handicapped/blind/Kosher/Halal/sensitivities/allergies] people demand...?' questions, "Yes, in many cases, they do!" And one of the best measures of any 'civilized' society is how it responds to those demands. Our society is responding reasonably well in terms of tobacco control, but still has a very long way to go; the lack of 100% smoke-free multi-unit dwellings being a prime example.
And finally, spare us the (obviously sarcastic) "Good luck": We won't be seeking government-subsidized housing.
Will the world ever be perfect? Of course not, but providing 100% smoke-free multi-unit housing is certainly one huge step toward excellence.

First, my heartfelt thanks and congratulations to Dr. Kreisman. A very eloquent and powerful 'premise'!

For anyone involved in tobacco issues -- pro or anti -- 1964 was a huge year! That was the year that the first U.S. Surgeon-General's Report on the Hazards of Smoking was released. As the half-century anniversary of that ground-breaking report fast approaches, political will -- or, more accurately, the lack thereof -- continues to be the biggest obstacle between all of us and 100% smoke-free lives, in general...and specifically, for the purposes of this discussion, 100% smoke-free housing.

When it comes to tobacco issues, politicians within each level of government (municipal, regional, provincial and federal), as well as bureaucrats who work in all of the departments within each of those governments, are no doubt absolutely delighted that, in fact, there are so many levels of government and so many departments within each level. That provides them with the perfect excuse to 'pass the buck' and treat any and all tobacco issues like a 'hot potato'..."Nope, that's not our responsibility; you'll have to contact _________."[fill in the blank...once for each phone call you make...until you've finally gone full circle and wind up back at the one you started with...and give up in frustration]. Indeed, it seems that if there's one thing politicians do well -- dare I say, perfectly -- it's passing the buck and, in the case of tobacco, creating controversy where none exists!

But it's not all 'doom and gloom'.

ALL OF US who have experienced the very valid frustration, anger and adverse health effects of exposure to second-hand tobacco smoke must get organized...and lobby our city councillors, our MLAs and our MPs. As 'alone' and 'helpless' as we might sometimes feel -- especially during the actual assault (I ain't no lawyer, but I strongly believe that KNOWINGLY EXPOSING ANYONE ELSE, ESPECIALLY CHILDREN, TO SECOND-HAND SMOKE IS ASSAULT!) -- collectively, we are a huge force to be reckoned with.

I wish I -- or any of the Directors of Airspace Action on Smoking and Health (the world's leading ALL-VOLUNTEER anti-tobacco organization) -- had the time, energy and/or money to do the above-mentioned 'organizing', but I/we don't.

Even if we never get truly organized, all is not lost. If each and every one of us simply pledge to ourselves that we will make an ongoing and persistent effort to contact our local politicians and tell them about our experiences regarding smoking in MUDs -- AND DEMAND ANSWERS FROM THEM...ANSWERS THAT INCLUDE SOME SORT OF ACTION/FOLLOW-UP, TAKING IT TO THE NEXT LEVEL, ETC.

If I may offer one piece of advice... Advise the politicians you talk to of something they already know: Tell them that the evidence about the harmful and deadly effects of SHS is overwhelming...and that no legitimate (i.e., not paid by the tobacco industry or any of its well-paid 'puppets') doctor or scientist would even think about denying it! Then ask them why it is that, bearing in mind the above-mentioned overwhelming and damning evidence against SHS, the burden of proof continues to be on us to prove our case...to make the case as to why we (those of us who live in a MUD) are entitled to a smoke-free home. Use the loud music at 4:00 a.m. comparison: That is not tolerated...and smoking in MUDs should NOT be tolerated for the exact same reasons. Smoke, like sound, 'drifts' into surrounding units! And the "It (tobacco) is a legal product!" and "I'll do whatever I damn-well please in my own house!" / "The government has no place in the bedrooms of the nation!" arguments are thoroughly flushed down the toilet when we use the loud music analogy too! After all, stereo systems -- and the volume switches -- are legal products too, but...

Another comparison: We seem to be heading toward zero tolerance in terms of drinking and driving. Within reason, drinking (in and of itself) is fine...and driving (in and of itself) is obviously fine too. But the two activities, combined? Potentially deadly...and, for that reason, illegal...and punishable by a fine and/or jail! And virtually nobody -- not even the impaired drivers themselves (at least, once they sober up) -- disputes that! The exact same principles apply to smoking...and living in a MUD! Okay, I'm finding it extremely challenging to say, "Smoking, in and of itself, is fine!" with a straight face, but there it is...I said it. And, like driving, living in a MUD (in and of itself) is obviously fine too. BUT THE TWO ACTIVITIES, COMBINED? POTENTIALLY DEADLY! And, for that reason, it SHOULD BE illegal! Not to mention the fact that careless (read, "criminally negligent") smoking continues to be the leading cause of residential fire fatalities. And no, it's not always just the smokers who die!

Right or wrong, alcohol and tobacco are society's two 'legal' drugs. For some strange reason, we, as a society, generally accept and embrace the fact that, while people have a right to drink, as wih ALL rights, the right to drink comes with some responsibilities...and one of the the basic principles behind the law against drinking and driving is -- and plain old common sense dictates -- "Do as you please! Swing your fist wildly through the air! Drink a gallon of tequila, if you must! Smoke 10 cigarettes at a time! All totally legal activities...fill your boots!

But if your fist comes into contact with another person's face, you're going to jail! Drive a car after that gallon of tequila? Assuming you don't die of alcohol poisoning or kill yourself (and others) in an accident, you're going to jail! Smoke even just 1 cigarette in a MUD? Well, for some strange reason, apparently that is [currently] okay! What's up with that?

Second-hand [tobacco] smoke kills far more people (i.e., non-smokers) than are killed in impaired driving accidents! Yet those SHS victims are, generally, blissfully ignored. I guess their deaths are just not quite as spectacular/newsworthy; no twisted metal, no shattered glass, no red and blue lights and sirens, no blood and guts! Impaired driving accidents are often front page stories, while SHS deaths are relegated to the obituary section, right beside so many prematurely dead smokers. Again, unlike impaired driving cases, for tobacco deaths (whether they be non-smokers or smokers), there is rarely, if ever, any mention of the REAL cause of death. Most often, the obit will simply say "cancer" or "heart disease" (or the even more vague, "after a long illness"); once in a while, an obit will mention "lung cancer" (bearing mind mind that about 15% of lung cancer deaths are caused by something other than tobacco), but I have NEVER seen an obit -- for a non-smoker or a smoker -- that says, "lung cancer (or chronic bronchitis, emphysema or COPD) or heart disease...CAUSED BY SMOKING!" (emphasis mine). However, I digress...

Again, my thanks to Dr. Kreisman.

Notwithstanding the fact that this issue should have been dealt with and resolved decades ago, let's ramp up the fight, kick some political butt and, in honor of the late U.S. Surgeon-General Luther Terry, shoot for...

Thank you for your article highlighting this desperate need. I am an asthmatic who has been forced through six hellish moves because of neighbours who smoke. Five of those times was from places that were advertised as smoke-free and in which smoking was specifically prohibited in the lease.

Your solutions are excellent, although I don't have high expectations of our tobacco-friendly premier doing anything about this problem.

One of the biggest problems I encountered was that people were unwilling to speak up. Many others were as upset about the smoking in the apartments as I was, but didn't want the management to see them as trouble-makers. They would say, "What's the point? Nothing will change." So I was always the only one speaking up, and would be told, "No one else is complaining. You're the only one who is bothered." And I would be treated like a trouble-maker, which would confirm the fears of those too afraid to speak up.

This problem will not go away until everyone who wants smoke-free housing speaks up and doesn't shut up or go away until everyone who wants it has it. You would be surprised at how many housing providers want to go smoke-free but don't think it is legal or possible to enforce. I used every one of my moves to educate landlords and managers, even if I couldn't live in their building. And many were surprisingly receptive; they simply hadn't realized that this was something they could actually do.

Unreceptive governments and housing providers are only part of the problem. People need to stand up for their rights, because united we can change this.

Thank you, Dr. Kreisman, for being one of the ones willing to speak up.

I have now had to abandon 2 attached dwellings which I owned because the owners on the other side lied about smoking and continued to smoke.

In the latest case, I was victim of a conspiracy involving a real-estate agent, a tenant, and an owner. All to lure me into buying a home I truly could not live in. My legal recourses and resources are very limited. In essence, millions of people are victims and have no defender.

We must recognized how depraved the behavior of smokers can be. There can be no compromise. The law must do the right thing.

After years of complaining about secondhand smoke, one of three, a 70 year old woman bravely files a dispute resolution claim against her landlord for failing to stop the infiltration of secondhand smoke from marijuana, and cigarettes. She was diagnosed with asthma, and her doctor wrote a letter asking that the landlord please do something to resolve this problem. What she receives is a dispute resolution officer that seems to be pissed, having a bad day, who is intimidating and abrupt, and in under 40 minutes brings the conference call to an end. The owner announces they have investigated thoroughly for evidence of secondhand smoke, and they have not found any. Furthermore, the landlord is a doctor, a retired doctor, and he would not have any of that happening in his building. There is no evidence that they have done anything. There was no evidence package. The only problem they have is this one elderly woman who complains of secondhand smoke, and marijuana, where non exists. The manager lives beside this tenant, and they do not smell marijuana or any other secondhand smoke.

A young mother with two children living in a hotel room, went to the local news asking for help with finding housing. A local landlord, non-profit with a BC Housing service contract, offered her a townhouse. Greatful and relieved, she moved - only to find she was sandwiched between two families of smokers, four on one side and two on the other. Her landlord suggests she move since obviously her neighbours are not going to stop smoking and not move. She would. She has asked BC Housing to move her. She has applied for every program to move her out of the situation. Her doctor knows about it, since he filled out the forms. Emergency knows about it since she has had to take her children to emergency as a result of the secondhand smoke infiltrating the bedrooms. The local health authority knows about it, because she appealed to them for help. The municaplity knows about it, but it is not under their jurisdiction. After 19 months, who helps this woman in this situation...with the secondhand smoke, and being the brunt of belligerent managers and smoker tenants?

A nine year old and his brother 13, email tobacco control and Ministry of Health asking for help with their parents who smoke, and the response to these children was that they obviously knew the problem, provided them with links to brochures, and suggested they talk to their parents with the help of the brochures.

Where do people go for help? Real practical, advocate-type help? Why is it so impossible to get help? Why is it so impossible to even create a dialogue on this situation with the relevant health authorities, or even with landlords? What is unsolvable about these situations? The crux of the problem is that smokers are addicted, addiction is a mental illness, therefore they cannot be approached to stop smoking. But can they be asked to be polite, considerate, and smoke away from others who are made sick from the smoke. Can they be asked to use products to get their nicotine hit? It seems to me that everyone, non-smokers and those in authorityhere, are afraid of smokers belligerence. Misplaced empathy is also a problem, since there appears a lot for the blustering smokers, and none for the non-smokers who are attempting to address a serious health problem. And with no advocacy access, there is no one to help prepare documents to make claims, and people just cannot stand the conflict of confronting these issues.

Since this is a health issue, doctors need to provide the help to protect their clients...and make the case for legislation.

Dr Kreisman makes a cogent point about a matter of great significant to public health. Vancouver is renowned in North America for the population density of its vibrant downtown core, where multilevel housing is positive element within the struggle for an environmentally friendly footprint. With this comes a sense of community, shared awareness and pride that such housing does not suffer the association with the marginalized and destitute as it does in so many other cities. A major threat to this dynamic is the presence of second-hand smoke in such confined space, which is duly offensive to most of those aware of its deleterious effects. I am impressed that Canadians in general share a respect for collective good that in appropriate context gives individual rights somewhat less exalted status that they enjoy in the United States. This may inspire a ban on smoking in multi-unit housing.

I was very glad to have stumbled on this article. I have a lot of allergies, the worst is to tobacco. Being in my mid-30s, I grew up in a time when avoiding smoke in public places - even school - wasn't possible. I spent much of my childhood sick as a result. Things have gotten a lot better in public places, but I'm still limited to single family homes as a housing option - and financially, that option isn't feasible in many cities (Vancouver is at the top of the unffordable list, which is why living there is out of the question for me presently.

I've never understood why the "right to smoke" seems to trump the right to breathe and be healthy in one's own home. In complexes with more than one building, I've long advocated some buildings be designated as smoke-free - probably 80 percent at least, as that's the percent of the population that doesn't smoke in most cities.

But perhaps it's time to go a step further and ban smoking in multi-unit buildings entirely. I don't choose my allergies, but smokers choose to smoke. Why am I the one that should be forced to pay extra for my accommodations as a result of a choice someone else made?

''Why am I the one that should be forced to pay extra for my accommodations as a result of a choice someone else made?''

For the same reason many people are forced to pay extra or go out of their way for their special needs. You do of course realize that people intolerant to miniscule amounts of smoke (or smell rather) that seeps from one apartment to another is the exception, don't you? Do handicapped people demand an elevator in every building? Do blind people demand brail writing on every wall in every building? Do Kosher or Halal people demand that the building be free of any bacon odors because it is offensive to them? Do people with sensitivities to chemicals in household products demand that noone uses them in the building? Do people with perfume allergies demand that noone in the building wears any just in case they have to share the same elevator with them or meet them in the stairway?

Special personal requirements are the person's responsibility, not the private property owner's. The best you can ask for is that the government subsidizes housing for people with special needs. Good luck.